For many Port-au-Prince residents and those throughout Haiti, the situation is catastrophic, says the Red Cross. Estimates now suggest that some 200,000 may have died and that one million have been made destitute.

The people of Port-au-Prince are now struggling even to survive. Nerves are fraying as hungry and thirsty survivors face up to the reality of how much they have lost, says the International Committee of the Red Cross (ICRC), which has stepped up its efforts and is now reaching thousands with food, water and medicine.

Andrew Hogg of the UK-based international development agency, Christian Aid, told the BBC yesterday (18 Jan) that the fuel shortages, road blockages, administrative holes and other logistical problems are making life "unimaginably difficult" for those bringing aid. But the determination to do so remains.

A problem of armed gangs and looting is emerging, with news that the number of criminals, many of them hardened offenders, who have escaped from jail is between 3-5,000.

Overall, "access to shelter, sanitation, water, food and medical care remains extremely limited," said Riccardo Conti, the International Committee of the Red Cross head of delegation in Haiti on 18 January 2010.

He continued: "Even if the presence of aid agencies is starting to be felt in hospitals and clinics, many medical facilities in Port-au-Prince still lack staff and medicine. Given the scale of the needs, the task facing humanitarian organisations is daunting."

In Christ-Roi, Delmas, Carrefour and nearly all other areas of the city, the streets are packed with people, makeshift tents and piles of burning trash. For many residents, the search for dead bodies seems to be over. Men sit on top of collapsed buildings, breaking apart cement blocks and pulling sheets of scrap metal from the rubble in an attempt to salvage whatever can be put to use. Long, chaotic lines are forming at the few petrol pumps that still work. Armed guards and police try to regulate the flow of customers with little success.

"People are becoming more aggressive because they need food and water," said a 29-year-old survivor named Sherley. "As we start to figure out that our loved ones are not going to be found, it is as if we are finally understanding what is happening to us. Today, people are fighting to survive."

The ICRC is continuing to strengthen its response to the crisis and is now providing water in three areas of the city. Six truckloads of ICRC relief supplies, including medical items, arrived in Port-au-Prince on Sunday night, immediately boosting the organisation's capacity to help those in need.

Almost seven days after the quake, the health and sanitation situation is growing increasingly precarious in the makeshift camps.

With virtually no infrastructure or services left and vast numbers of people sleeping in the streets, the availability of toilets and fresh water is extremely limited. All over Port-au-Prince, the stench of urine is overpowering.

"We must rapidly address these water and sanitation issues if we want to minimise the risk of an outbreak of disease," said Mr Conti. "This is really paramount."

The ICRC is now using water trucks to provide clean water for around 7,500 people in three makeshift camps. Latrines for around 1,000 people have also been built in the Delmas area.

"Water does not merely quench thirst," said Guy Mouron, the ICRC's water and sanitation coordinator in Haiti. "Being able to wash helps maintain hygiene and helps restore dignity when you have lost everything."

Prices for food and transport have skyrocketed since last Tuesday and incidents of violence and looting are on the rise as the desperation grows.

"People have lost everything. There is no cash and the black market is thriving," said Verlène, a 31-year-old administrative assistant. "In Delmas, where I live, there is looting. We are now barricading at night. Homeowners carry guns and use them. Yesterday, people started shouting that a tsunami was coming in order to scare people away so they could steal whatever's left."

ICRC delegates say there are vegetable and fruit vendors in the streets, but few customers because no one can afford to buy the food. In one Port-au-Prince neighborhood, the price of bread has doubled since last week.

Those who have enough money to do so are going away. Buses in Martissant are packed with people leaving the city, while the border with the Dominican Republic is reportedly jammed with Port-au-Prince residents trying to get out. Near the airport, Haitian-Americans are lining up in front of the US embassy, trying to leave the country.

Meanwhile, inside Port-au-Prince, indifference is setting in. People have begun dropping dead bodies in front of doors. "Along the Route des Frères last night, I saw people burning bodies in an improvised grave on the side of the street," one woman told the ICRC.

The International Committee of the Red Cross, which was already present and active in Haiti before Tuesday's earthquake, works as part of the wider International Red Cross and Red Crescent Movement and co-operates closely with the Haitian National Red Cross Society.

In addition to providing clean water for around 7,500 survivors, the ICRC has provided items to the Haitian Red Cross for the 10 first-aid posts it has set up in various makeshift camps around the city. The posts are now operational and are expected to provide basic care for thousands of patients.

The ICRC has also provided over 500 body bags to the Brazilian UN mission in charge of body removal in Port-au-Prince.

Prior to the arrival of six trucks carrying nearly 40 tonnes of ICRC relief supplies on Sunday, the organisation had already supplied medical kits for the treatment of 2,000 patients to two Port-au-Prince referral hospitals with support from the Haitian Red Cross. Hundreds of blankets and plastic sheets had also been distributed.

A second ICRC rapid deployment team is expected to arrive in Haiti in the coming day or two and will provide more forensics, tracing, nursing, communications and logistics support to staff already on the ground.

In addition, ICRC delegates have visited several places of detention in Port-au-Prince to assess needs.

Given the scope of the disaster, the ICRC is not in a position to provide exact figures about the number of deaths or injuries resulting from the earthquake.

Meanwhile, the first Red Cross/Red Crescent emergency response units (ERUs) of the 16 which have been mobilised, have arrived in Port-au-Prince. A Norwegian rapid deployment hospital and a Finnish basic health-care unit with medical supplies arrived on Sunday and surgery commenced yesterday.

An American relief ERU is operating in Port-au-Prince. A German basic health-care unit and a Spanish telecom unit will arrive today. A British Red Cross logistics ERU is already set up in Santo Domingo, and a field hospital and a water and sanitation unit will arrive in the next few days.

The ICRC says it is working closely with the International Federation to ensure that all the ERUs expected to arrive in Haiti will be able to land as quickly as possible.